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A wheezy student
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
The following initial investigations should be done after initial emergency treatment: an FBC will show if this patient is anaemic. If the total white cell count is raised, white cell differential will guide you on possible causes for an exacerbation, which include infectionurea and electrolyte concentrations should be measured as the patient may be dehydratedblood cultures should be taken if the patient is pyrexiala chest X-ray may show the presence of infection, and should be done if a pneumothorax is suspectedan ECG to exclude co-morbiditiesif the patient has a cough productive of purulent sputum, a sputum sample should be sent for microscopy and culture. This can help to detect the presence of infection and will give information on antibiotic sensitivities.
Dermal filler complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Once you have administered the initial emergency treatment, then it is your duty to follow the patient up daily to give you the best chance to intercept any necrotic areas forming. It is strongly advisable that should your patient’s suspected avascular necrosis worsen in front of you despite your best efforts then refer them to hospital immediately. If on daily review their symptoms do not improve or become worse, it is imperative that they see an experienced plastic or maxillofacial surgeon urgently for surgical intervention. If a necrotic area progresses to develop, a large arterial ulcer will form with a significant risk of infection and scarring. When referring your patient, write a letter outlining the dates of treatment, product and volume used, and which steps you have taken to manage it so far.
Management of the Sick Child
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Assessment of ‘D – disability’ includes assessing a patient’s level of consciousness. An altered level of consciousness can be due to many reasons (medical and surgical). This is an acute life-threatening emergency and requires prompt recognition and emergency treatment.3 The child should be evaluated using a recognised consciousness scale such as AVPU. Other examples include Paediatric Glasgow Coma Scale (PGCS) (<15 indicates altered level of consciousness) and Blantyre Coma Scale (used in cerebral malaria, <4 indicates altered level of consciousness).
Preeclampsia: state of art and future perspectives. A special focus on possible preventions
Published in Journal of Obstetrics and Gynaecology, 2022
Özge Kahramanoglu, Antonio Schiattarella, Oya Demirci, Giovanni Sisti, Franco Pietro Ammaturo, Carlo Trotta, Federico Ferrari, Agnese Maria Chiara Rapisarda
Postpartum PE, also known as late postpartum PE, represents a rare condition that develops within 48 hours of childbirth. Sometimes the onset can be delayed up to six weeks or later after childbirth. If left untreated, it could evolve in eclampsia, pulmonary oedema, stroke, thromboembolism or HELLP syndrome. The ACOG guidelines recommend clinic surveillance for at least 72 hours postpartum to identify early signs and symptoms of PE. A follow-up blood pressure check 7–10 days later should be performed (Hypertension in Pregnancy 2013). Emergency treatment is warranted when criteria for severe PE are met. Similarly to antepartum PE, the treatment is based on immediate-release oral nifedipine, mainly when intravenous access is not disposable (ACOG 2019b) and if it is not available, labetalol and hydralazine represent valid choices (ACOG 2019b). Magnesium sulphate is helpful for seizure prophylaxis for high-risk women but is not recommended as an antihypertensive agent (ACOG 2019b).
Preventing disease progression in Eisenmenger syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
Ana Barradas-Pires, Andrew Constantine, Konstantinos Dimopoulos
Bleeding can manifest in many forms, including hemoptysis, epistaxis, mucocutaneous (gingival) and gastrointestinal bleeding, menorrhagia and cerebral bleeding. Hemoptysis is not infrequent, including in the context of a pneumonia, when it is usually mild and self-limiting. Life-threatening hemoptysis can occur in cases of significant pulmonary hemorrhage and requires emergency treatment, including urgent transfusion of red cells, platelets and other clotting factors, reversal of anticoagulation, lung isolation using single lung ventilation and involvement of interventional radiologists to embolize bleeding vessels (including hypertrophied bronchial arteries). Thoracic surgical involvement should be sought in severe cases, but rigid bronchoscopy and lobectomy carry their own risks. Hemoptysis has become less common as a mechanism of death since Paul Wood described his patient series over half a century ago, but pulmonary hemorrhage as a result of bronchial arterial bleeding, bleeding from aorto-pulmonary collaterals or aneurysmal pulmonary artery rupture remain most-often fatal events. Strategies for preventing this and other forms of bleeding need to be considered (Table 4), and managed with the appropriate specialist input, investigated and managed appropriately in a specialist center with PH and CHD input.
Emergency vs elective ureteroscopy for a single ureteric stone
Published in Arab Journal of Urology, 2021
Abdullatif Al-Terki, Majd Alkabbani, Talal A. Alenezi, Tariq F. Al-Shaiji, Shabir Al-Mousawi, Ahmed R. El-Nahas
Emergency active treatments of ureteric calculi in the form of SWL [6,7] or URS [8–10] within 48 h after a colic episode have been reported. The advantage of emergency active treatment is based on immediate retrieval of the obstructing stone, therefore, decreasing the number of surgical interventions (i.e. relief of obstruction in one session and then treatment of the stones in the second). This will result in reduction of follow-up visits, radiation exposure and ultimately the costs [9]. Another value of emergency active treatment is decreasing morbidity and mortality of delayed treatment [4]. However, emergency treatment is suitable only for a certain group of patients who have no complications at presentation or who are not deemed at high risk of development of complications [11].